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Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
Health reform and workforce issues murray
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Health reform and workforce issues murray

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Health & Medicine Policy Research Group hosted a forum, “Health Reform and the Health Care Safety Net: Challenges and Opportunities,” on July 9 to explore the potential impact of health reform on the …

Health & Medicine Policy Research Group hosted a forum, “Health Reform and the Health Care Safety Net: Challenges and Opportunities,” on July 9 to explore the potential impact of health reform on the health care safety net nationally and in Illinois specifically.

The forum explored challenges and opportunities presented by health reform in Illinois, and examined the impact on community health centers, safety net hospitals, the health workforce, and vulnerable populations. Speakers included

*Michael McRaith, Director, Illinois Department of Insurance
*Julie Hamos, Director, Illinois Department of Healthcare and Family Services
*Claudine Swartz, Assistant Vice President for Policy, National Association of Public Hospitals and Health Systems (NAPH)
*Bill Foley, CEO, Cook County Health & Hospitals System
*Philippe Largent, VP for Government Affairs, IL Primary Healthcare Association
*Linda Murray, Chief Medical Officer, Cook County Department of Public Health, President-Elect, APHA
*Roberta Rakove, Senior Vice President, Government Affairs, Sinai Health System


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  • 1. Workforce Issues : Patient Protection & Affordable Care Act - 2010 Linda Rae Murray M.D. MPH Cook County Department of Public Health
  • 2. U.S. HEALTH WORKFORCE, 2004 Health professions & Health Care Occupations Settings 4.5 million 4.2 million 8.6 million other health health workers professionals professionals The U.S. health workforce consists of over 17 million workers and comprises almost 12% of the total workforce.
  • 3. Average Annual Number of Physician Visits per Capita, 2007 8 7.5 7.0 7 6.3 6.3 6.3 * Americans have fewer 6 5 5.8 5.7 5.0 4.7 physicians 4 4.0 3.8 2.8 3 2 * We see them less often 1 0 GER ITA** AUS FR OECD CAN* NETH UK NZ SWITZ US* SWE* Median * About 70% are specialists Number of Practicing Physicians per 1,000 Population, 2007 and only 30% primary care 4 3.9 3.9 3.9 3.7 3.6 3.5 3.4 3.2 *Most OCED nations have 3 2.8 2.5 2.4 2.3 2.2 50-60% primary care 2 doctors 1 0 NETH NOR SWITZ ITA SWE* GER FR OECD AUS* UK US NZ CAN Median
  • 4. Obesity (BMI>30) Prevalence Among Mortality Amenable to Health Care Adult Population, 2007 34.3 35 30 26.5 25 24.0 20 15.4 15 13.6 11.2 10.5 10.2 9.9 10 9.0 8.1 5 0 US* NZ UK CAN GER** NETH FR* SWE ITA NOR SWITZ Potential Years of Life Lost Because of Diabetes per 100,000 Population, 2007 99 100 80 64 60 Generally speaking: the 37 health status of Americans is 40 36 36 35 33 31 29 25 WORSE than comparable 20 19 nations. 0 US** NZ** NOR* SWE* OECD GER* NETH ITA* FR* UK SWITZ* Median
  • 5. Flexner Report : 100 Years • Published in June, 1910 • Brother of the President of the Rockerfeller Institute • Reformed medical education • Modeled after John Hopkins – Which was modeled on Germany • Schools eagerly cooperated in survey hoping for funds
  • 6. Actual decrease in Medical Schools compared to recommendations
  • 7. Impact of the Flexner Report Number of Medical Schools • Flexner report saw a 51% decrease in 200 160 166 medical schools after 150 it was issued Flexner Report 1910 100 81 • Driven by a $500 75 52 million investment in 50 reforming medical schools 0 1850 1870 1900 1904 1922
  • 8. Flexner Report … The Negro must be educated not for his own sake, but for ours. He is, as far as the human eye can see, a permanent factor in the nation. He has rights and due value as an individual. But he has besides the tremendous importance that belongs to a potential source of contagion….. Of the seven medical schools for Negroes in the United States, five are at this moment in no position to make any contribution of value to the problem…
  • 9. Flexner Report … the upbuilding of Howard and Meharry profit the nation more than the inadequate maintenance of a larger number of schools. They are of course, unequal to the need and opportunity.”
  • 10. Patient Protection & Affordable Care Act: TITLE V - Health Workforce Provisions • National Workforce Commission • Increasing supply of health care workforce • Enhancing education & training • Public Health Sciences Track • Supporting Existing Workforce • Strengthening Primary Care & other workforce improvements • Other stuff
  • 11. National Workforce Commission • Establishes a National Health Care Workforce Commission to serve as a national resource to: – Determine whether the demand for health care workers is being met; – Identify barriers to coordination and encourage innovation; – Disseminate information on retention practices for health care professionals and; – Shall review current and projected health care workforce supply and demand and make recommendations regarding healthcare workforce priorities, goals and policies. • The Commission shall communicate and coordinate with a variety of federal agencies and departments……. Public health professionals are included in the definition of health care workforce and the definition of health professionals. Public health workforce capacity is also included in the high priority areas list.
  • 12. National Workforce Commission • State Health Care Workforce Development Grants: Establishes a competitive healthcare workforce development grant program to enable State partnerships to complete comprehensive planning and to carry out activities leading to coherent and comprehensive health care workforce development strategies at the State and local levels. – Authorizes $8 million for planning grants and $150 million for implementation grants for FY 2010 and such sums for each subsequent year. • Health Care Workforce Assessment: Codifies the existing National Center for Health Care Workforce Analysis (HRSA) to provide for the development of information describing the health care workforce and the analysis of related issues and collect, analyze and report data related to programs under this title. The National Center and relevant regional and State centers and agencies shall collect labor and workforce information and provide analyses and reports to the Commission.
  • 13. Increasing Supply of Health Care Workforce • Support for pediatrics, pediatric sub-specialties, child, adolescent mental & behavioral health • Establishes a public health & allied health workforce loan repayment program to eliminate critical public health workforce shortages in Federal, State, local and tribal public health agencies. • Authorizes the Secretary to make grants or enter into contracts to award scholarships to mid-career public health and allied health professionals to enroll in degree or professional training programs. Authorizes $60 million for these programs in FY 2010 and such sums as necessary for FY 2011 - 2015. • Strengthens National Health Service Corps • Support for Nurse Managed Health Clinics
  • 14. Enhancing education & training • Primary care training – Medical students, residents, physician assistants , CME for primary care physicians • Training for faculty to teach primary care • Training in community based settings • Plan, develop and operate interdisciplinary graduate degree programs in public health and other health professions • Capacity building in primary care – Direct care worker, dentistry (general, pediatric & public health) as doctors and mid-level – Geriatric training – Mental & Behavioral health – Cultural competency, prevention, public health proficiency – Nursing education (midwives, faculty) – Community Health workers
  • 15. Public Health Sciences Track • Directs the Secretary (subject to the availability of appropriations) to establish an Epidemiology and Laboratory Capacity Grant Program to award grants to eligible entities to assist public health agencies in improving surveillance for and response to infectious diseases and other conditions of public health importance. Authorizes $190 million for each year of fiscal years 2010 - 2013 to carry out this section. • Authorizes funding for fellowship training in applied public health epidemiology, public health laboratory science, public health informatics, and expansion of the epidemic intelligence service in order to address documented workforce shortages in State and local health departments. Authorizes, for each of fiscal years 2010 through 2013, $5 million for epidemiology fellowship training programs, $5 million for laboratory fellowship training programs; $5 million for the Public Health Informatics Fellowship Program; and $24,500,000 for expanding the Epidemic Intelligence Service
  • 16. Support existing workforce • Loan repayments & fellowships – Medically underserved areas • Area Health Education Centers • Workforce Diversity • Primary Care provider training – Training in public health, health promotion, chronic disease management, mental and behavioral health
  • 17. Other Workforce Improvements • Family to family health information centers • Training of Personal or Home Care Aides • Teaching Health Centers Development grants • Increased payments to primary care providers • Rural physician training • School based health centers • Patient Navigator programs • Increased funding Community Health Centers • Increased funding Trauma Centers (40% for safety net centers)
  • 18. Source: Steinecke, Acad Med. 2010, Vol 85 (2) p 236
  • 19. Paul Bertau Cornely M.D. MPH 1906 - 2002 • First Black DrPH (University of Mich) • First Black doctorate in anatomy • First Black President of American Public Health Association • First Black President of Physician’s Forum • One of the founders of the Medical Committee for Human Rights
  • 20. Status of Black Physicians in 1932 • Blacks were 2.5% of all physicians • Population ratios MD: Pop – 1 Black doc : 2,988 Blacks – 1 white doc : 727 whites
  • 21. Golden Period for Black Physicians 1900 - 1920 • Number of Black physicians DOUBLED – 1900 : 1,734 Black physicians – 1920 : 3,885 Black physicians • HIGH POINT 1920 – Blacks were 2.68% of all physicians – 1 Black MD : 2,694 Black people • UNTIL around 1970-80 • Today : 2010 – 4.0% of all U.S. physicians are Black (30,598)
  • 22. Under-represented Minority Medical School Graduates by Race & Ethnicity 1972 - 2007
  • 23. Under-represented Minority Medical School Graduates by Race & Ethnicity 1972 - 2007
  • 24. Source: AAMC
  • 25. ALL DELIBERATE SPEED: In 2005 African- Americans, Native Americans and Latinos made up 25% of the U.S. population…. But comprised only 6% of the physician population.
  • 26. Percentage of Mental Health Workforce by Race , Ethnicity 2005 Race, Total U.S. Physicians Psychiatrists Psychologists Social Ethnicity Population Workers White 67.0 77 81 93 92 Latino 14.0 4 5 3 3 Black 13.0 5 3 2 4 Asian 5 14 11 2 1 American 1.5 0.1 0.1 0.3 0.2 Indian/Alask Source: Miranda, J. (2008) American Journal of Psychiatry 165:1102
  • 27. Standard Primary Care Year Estimates for 2008 Graduates Source: Bowman : Rural & Remote Health 2008 : 8(3)
  • 28. Principles of Patient-Centered Medical Home* • Personal Physician: on going relationship providing first contact, continuous & comprehensive care • Physician-directed medical practice: physician leads team • Whole person orientation: responsible for directing all care and arranging for referrals • Coordination and/or integration of care: across all types of care (ambulatory – nursing home) • Quality & Safety: care plans, evidence based medicine, performance measures, mutual participation • Enhanced access: open scheduling, expanded hours, use new tech methods for communication • Payment: added value of medical care home * American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association
  • 29. Crisis in the Workforce • Still feudal crafts • Medical home vs. primary care • Accountable care organizations • Not simply a question of shortages & mal-distribution • Need to transform how we practice • Requires fundamental transformation of our Medical Care System into a Health Care System • Health care is a human right • Requires a “Flexnerian” investment in education across disciplines

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